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Neuralgia is a brief, acute and intense pain (similar to an electric shock) caused by nerve pathologies.
Patients experience such a feeling of discomfort in areas where nervous terminations are present.
If this pain is experienced on the face, the neuralgia is the consequence of a damaged branch of the trigeminal nerve.
Painful symptomatology can be adverted in the areas where the trigeminal nerve endings are located: eyes, lips, nose, scalp, forehead, external cutaneous areas, internal mucous membranes of mandible and maxilla, and teeth.
It is estimated that about 1 person every 10,000 suffers from trigeminal neuralgia, and often times the subjects affected by this disorder are over 40 years old.
Even if the insurgence of pain is often brief, trigeminal neuralgia triggers a process so intense that it becomes quite debilitating and hard to handle, both physically and emotionally.
If experienced on a dental level, this pain can mimic a common “tooth ache,” leading to difficulty in chewing, brushing your teeth or drinking, since the pain is often accentuated by natural and spontaneous acts such as smiling or touching the cheek.
Structural causes include damages to the myelin sheath (a casing that guards and isolates the nerve), which causes the electrical impulses travelling in the nerve to be irregular or excessive, hence activating painful regions or deactivating pain-inhibiting regions of the brain.
The damage can even be caused by the swelling of a blood vessel (aneurism) or by an anomalous development of the latter, which compresses the trigeminal nerve. This anomalous compression, in time, produces a continuous irritation of the nerve, causing pain.
Another cause can also be physiological ageing, leading to a greater flabbiness of blood vessels, which may ease down on the nerves and cause pain symptoms.
Especially in younger individuals, trigeminal nerve damages can be a consequence of multiple sclerosis, which leads to a progressive deterioration of the myelin sheath.
The presence of a tumour can also deteriorate the myelin sheath or compress the nerve, triggering the above-mentioned symptoms.
Shingles, caused by the same virus of the chicken pox (Herpes Zoster), can also affect the trigeminal nerves, leading to neuralgia.
The treatment of neuralgia can be either pharmacological and/or surgical.
In most cases, trigeminal neuralgia can be cured with pharmaceuticals aimed at eliminating the painful symptomatology (clonazepam, phenytoin, lamotrigine, oxycodone, gabapentin, pregabalin, morphine, codeine, fentanyl and carbamazepine).
If pharmaceuticals are not tolerated or result to be non-effective, then surgery is the only alternative. Surgical therapy involves techniques such as slightly invasive percutaneous procedures (trigeminal termorhizotomy and radiofrequency) or more invasive interventions of micro vascular decompression.
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